Going large on obesity scares

Posted on April 1, 2016

A report published in the Lancet today suggests that there are more people globally who are obese than underweight. Some would call that good news, but in an era obsessed with the idea that we are killing ourselves through poor lifestyles, this is supposed to be a global emergency - and something must be done to stop it.

Since 1975, the proportion of the world's male population that is obese went up from 3.2 per cent to 10.8 per cent. For women, obesity rates rose from 6.4 per cent to 14.9 per cent. Those are substantial rises, but a little context is required. In 1975, all the talk was about mass starvation as populations in poorer countries rose rapidly. But the Lancet report notes that the prevalence of underweight has gone down sharply, from 13.8 per cent to 8.8 per cent for men, and from 14.6 per cent to 9.7 per cent for women. That's a remarkable achievement, the product of billions of people being taken out of the worst levels of poverty.

The report authors, however, are less sanguine. In 2013, the World Health Organisation (WHO) agreed a global action plan for the prevention and control of noncommunicable diseases. Among the targets set was to halt the rise in rates of diabetes and obesity. The authors note that, on current trends, there is little prospect of that happening.

Is that a disaster? Are we facing a timebomb of illness and death due to rising obesity? As the authors admit, 'although adiposity has been consistently shown to be an independent risk factor for several NCDs in individual-level epidemiological studies, at the population level, the effect of rising BMI on the course of mortality reduction has so far been somewhat small in high-income countries'. In other words, in richer countries, we've got better at spotting the signs of potential ill-health and are learning to treat these problems better. Perhaps that's also because the claims made in the past about obesity have been overblown. That's certainly true when it comes to forecasts of future obesity rates, which have frequently been overstated.

However, the authors do argue that in the poorest countries with less access to modern healthcare, such medical solutions may not be available. Maybe there, things will be different. But is this a case of moving the goalposts? In any event, screening people for diabetes, for example, need not be terribly expensive and medication will get considerably cheaper as drug patents come to an end.

For those of us concerned about consumer choice, the really worrying comments come right at the end:

Present interventions and policies have not been able to stop the rise in BMI in most countries. The global NCD target on obesity, although ambitious in view of past trends, has engendered a new look at policies that could slow down and stop the worldwide increase in BMI. To avoid an epidemic of severe obesity, the next step must be to implement these policies, and to systematically assess their effect.

Guess what that means? More boneheaded panic policies like George Osborne's sugar tax, which will have a trivial effect on obesity rates and wider health. As the Nanny State Index, published this week, points out, state intervention across Europe around smoking, vaping, alcohol and food has been ineffective - 'there is no correlation between nanny state regulation and higher life expectancy'. Yet these obesity figures will surely be used to justify even more interference in our lives.

Even though we are living longer than ever before - in the period covered by the report, global life expectancy at birth has increased from less than 59 years to more than 71 years - and even though the number of people who are chronically malnourished is at a historic low, the control freaks within the health community are using figures which should be a cause for celebration as an excuse for more state intervention.